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Biomedical subjects

J F Mooney

Publications and source records attributed to J F Mooney.

At least 19 recordsLinked to original sources
PubMed2001

Knee flexion contractures: soft tissue correction with monolateral external fixation.

We assessed the efficacy of progressive soft tissue distraction using monolateral external fixation in the management of severe knee flexion contractures. We prospectively evaluated 10 knee deformities in seven pediatric patients. After gradual distraction using the modified Orthofix Limb Reconstruction System (LRS), most recent functional status and knee range of motion were determined. This treatment was applied to 10 extremities in seven patients, ranging in age from 2 to 16 years. Diagnoses included arthrogryposis (4), sickle cell disease (1), previous sepsis (1), and congenital pterygium (1). Average preoperative flexion contracture was 80.5 degrees. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures. Management of knee flexion contractures using a monolateral fixator appears to be a viable alternative to extensive release or femoral osteotomy. Long-term follow-up will be essential to assess the overall risk of recurrence and complications.

Adolescent↗
PubMed2000

Treatment of soft tissue defects in pediatric patients using the V.A.C. system.

Twenty-seven consecutive pediatric patients presenting to the orthopaedic surgery or plastic surgery services were reviewed after completion of wound care with the Vacuum Assisted Closure (V.A.C.) system. Each patient presented with complex soft tissue wounds requiring coverage procedures. Patients with acute wounds and wounds present after nonsuccessful attempts at surgical closure (dehisced incisions and failed flaps) were treated. All soft tissue defects healed without extensive coverage procedures using the V.A.C. system. In the majority of patients, use of the V.A.C. system produced a profuse bed of granulation tissue over all exposed bone, tendon, joint, and/or hardware, which could be covered with split thickness skin graft. Other patients were treated successfully with delayed primary closure, local flap advancement (one patient underwent a pedicled cross-leg flap), or by secondary intention. Use of the V.A.C. device is valuable in increasing the rate of granulation tissue formation and healing of extensive soft tissue injuries in pediatric patients. This vacuum system aids in the debridement of necrotic tissue and local soluble inflammatory mediators that may inhibit the proliferation of granulation tissue. These improvements in the local wound environment seem to accelerate wound healing compared with traditional methods. Before the development of the V.A.C. system, a minimum of nine patients within this group would have required free tissue transfer to obtain adequate coverage. The V.A.C. device seems to permit earlier coverage with local tissue or split-thickness skin grafting techniques, thereby decreasing the need for extensive microvascular tissue transfers in pediatric patients.

Adolescent↗
PubMed2000

Perioperative enteric nutritional supplementation in pediatric patients with neuromuscular scoliosis.

Perioperative nutritional status has been shown to be important in minimizing complications after extensive spinal procedures. Traditionally, total parenteral nutrition has been used to supplement oral nutrition intake. Little information exists regarding the risks and benefits of enteric supplementation in pediatric patients. To assess use and safety of enteric nutritional supplementation after extensive pediatric spine surgery, a retrospective review was done of 21 consecutive pediatric cerebral palsy patients receiving enteric nutritional supplementation via nasal or gastric feeding tubes after, and/or between stages of, anterior and posterior spinal fusions. Enteric supplementation was maintained for an average of 9.1 days, and the lowest albumin and total protein levels were seen the third postoperative day. Enteric nutritional supplementation was found to be a safe alternative to total parenteral nutrition in pediatric cerebral palsy patients after spinal stabilization procedures. In addition, enteric feedings may be less costly than central hyperalimentation and do not carry the inherent risk of central venous access.

Adolescent↗
PubMed1999

Spinal deformity after selective dorsal rhizotomy in patients with cerebral palsy.

Selective dorsal rhizotomy is used widely as a means of treating spasticity associated with cerebral palsy. Little is known regarding the effect of the procedure on the development or progression of spinal deformity. The authors reviewed six patients with progressive deformity after rhizotomy. Prerhizotomy and postrhizotomy records of physical examinations and radiographs were reviewed retrospectively in an attempt to identify risk factors for development of and/or rapid progression of, spinal deformity. Detailed preoperative and postoperative evaluation of spinal alignment should be undertaken, particularly in those patients who may be at risk of rapidly progressive deformity.

Adolescent↗
PubMed1999

Congenital dislocation of the knee: overview of management options.

Congenital dislocation of the knee (CDK) is rare and includes a spectrum of hyperextension disorders of the knee. Early recognition of CDK is important, and careful evaluation is required to rule out associated hip deformity. Early manipulation, combined with splinting and casting, is the mainstay of initial treatment. Patients with seemingly fixed contractures may respond rapidly to serial casting and then can be placed in a Pavlik harness. Severe recalcitrant deformities or late presentation of the deformity may require surgical release. We highlight the importance of diagnostic categorization, show management options, and provide an overview of this rare but clinically significant problem. We present two case reports that illustrate the full range of management options.

Humans↗
PubMed1999

Fibrosarcoma of the sacrum in a child: management by sacral resection and reconstruction.

We describe the diagnosis and surgical management of fibrosarcoma of the sacrum in a pediatric patient. We retrospectively reviewed the literature and a case report. Total sacrectomy is a viable treatment option in the management of large malignant sacral tumors. The techniques used in adult patients can be extended to and improved upon for pediatric patients. The input of multiple surgical specialties is essential in the management of these lesions.

Bone Neoplasms↗
PubMed1997

Congenital pseudarthrosis of the tibia treated with free vascularized fibular graft.

Management of patients with deformities due to congenital pseudarthrosis of the tibia continues to be controversial. The use of free vascularized fibular grafts in the reconstruction of these deformities appears to be successful in this patient population but is not without potential for significant complications. Long-term evaluation, at least to skeletal maturity, is necessary to judge the success of any procedure done for any pediatric patient. This case illustrates the natural history of the vascularized free fibular graft for congenital pseudarthrosis of the tibia in a young child. Complications of this treatment modality did occur, including probable recurrence and fracture at almost 11 years post-index procedure. However, stable reconstruction leading to fracture union was achieved, and the patient has resumed full activities with little residual deformity.

Adolescent↗
PubMed1996

Patterning of functional antibodies and other proteins by photolithography of silane monolayers.

We have demonstrated the assembly of two-dimensional patterns of functional antibodies on a surface. In particular, we have selectively adsorbed micrometer-scale regions of biotinylated immunoglobulin that exhibit specific antigen binding after adsorption. The advantage of this technique is its potential adaptability to adsorbing arbitrary proteins in tightly packed monolayers while retaining functionality. The procedure begins with the formation of a self-assembled monolayer of n-octadecyltrimethoxysilane (OTMS) on a silicon dioxide surface. This monolayer can then be selectively removed by UV photolithography. Under appropriate solution conditions, the OTMS regions will adsorb a monolayer of bovine serum albumin (BSA), while the silicon dioxide regions where the OTMS has been removed by UV light will adsorb less than 2% of a monolayer, thus creating high contrast patterned adsorption of BSA. The attachment of the molecule biotin to the BSA allows the pattern to be replicated in a layer of streptavidin, which bonds to the biotinylated BSA and in turn will bond an additional layer of an arbitrary biotinylated protein. In our test case, functionality of the biotinylated goat antibodies raised against mouse immunoglobulin was demonstrated by the specific binding of fluorescently labeled mouse IgG.

Animals↗
PubMed1996

Neuromuscular blockade in the management of cerebral palsy.

Neuromuscular blocking agents-45% alcohol, 4% to 6% aqueous phenol, local anesthetics, and botulinum A toxin-have been used for many years in the evaluation and management of spasticity and movement disorders in children with cerebral palsy. Recent reports suggest that longer-acting neuromuscular blocking agents may impact positively on the natural history of dynamic deformity and improve health-related quality of life. This review includes the mechanism of action, techniques, indications, complications, and clinical outcomes associated with these agents.

Cerebral Palsy↗
PubMed1995

Progressive kyphosis and neurologic compromise complicating spondylothoracic dysplasia in infancy (Jarcho-Levin syndrome).

STUDY DESIGN: This is a case report and review of the literature. OBJECTIVE: To review the orthopedic literature regarding the spinal abnormalities found with spondylothoracic dysplasia, and to present the history and management of severe kyphosis with neurologic impairment in an infant with spondylothoracic dysplasia. SUMMARY OF BACKGROUND DATA: Spondylothoracic dysplasia (Jarcho-Levin syndrome) is a rare form of short-limbed dwarfism characterized by extensive vertebral and chest-wall abnormalities. Although the spinal anomalies generally are radiographically severe, no patient previously reported in the English orthopedic literature has required surgical stabilization. METHODS: The clinical findings, course, and surgical management of an infant with spondylothoracic dysplasia and severe congenital kyphosis are presented. This patient required anterior decompression and anterior/posterior spinal fusion to obtain stabilization. The follow-up from the index surgical procedure was 2 years. RESULTS: The patient underwent an initial anteroposterior fusion and decompression at 5 months of age. She underwent revision of both anteroposterior procedures 7 months later because of pseudarthroses and a progressive kyphosis. Her residual neurologic abnormality was minimal and she appeared to have a stable fusion at 24 months post-index procedure. CONCLUSIONS: The spinal abnormalities associated with spondylothoracic dysplasia may not be as benign as previously reported. Sagittal, as well as frontal, plane deformities may exist secondary to multiple hemivertebrae. Longer life span, possibly due to improved pulmonary care, may increase the incidence of deformities requiring intervention.

Dwarfism↗
PubMed1994

Spinal deformity associated with neurenteric cysts in children.

STUDY DESIGN: Neurenteric cysts are uncommon lesions originating from the primitive foregut that may involve adjacent vertebrae and spinal cord. Little is known regarding the natural history of these cysts and associated spinal deformity in children. Five patients with these cysts managed at the authors' institution from 1955 to 1993 were reviewed. OBJECTIVES: The goal of this retrospective review was to determine the natural history of these cysts in children, and to assess the surgical management in each of the five patients. METHODS: Medical charts and radiographic records were reviewed and, when possible, the patients were re-evaluated clinically. RESULTS: All patients had significant anterior vertebral defects, and four had severe kyphosis at presentation. Major complications occurred in three of the four patients treated surgically. CONCLUSIONS: Iatrogenic complications of surgical management of these cysts can be limited by combined anterior and posterior approaches, providing the most complete exposure and maximal stabilization of the associated deformity.

Child↗
PubMed1993

Directional atherectomy for long lesions: improved results.

The percutaneous treatment of complex stenoses, specifically long lesions, has improved substantially during the past decade. To determine the success of directional atherectomy in the treatment of long lesions, a cohort of 88 patients with lesions greater than 10 mm were evaluated and compared to 376 patients with long lesions treated with conventional balloon angioplasty. Directional atherectomy was successful in 97% and PTCA was successful in 93% of patients with long lesions. There were no differences in complication rates for these cohorts (< 2%). Directional atherectomy and PTCA appear to have safely and successfully broadened the percutaneous treatment of coronary disease to include long coronary stenoses.

Aged↗